Abstract
AimsThe first reports of declining hospital admissions for major cardiovascular emergencies during the COVID-19 pandemic attracted public attention. However, systematic evidence on this subject is sparse. We aimed to investigate the rate of emergent hospital admissions, subsequent invasive treatments and comorbidities during the COVID-19 pandemic in Germany.Methods and resultsThis was a retrospective analysis of health insurance claims data from the second largest insurance fund in Germany, BARMER. Patients hospitalized for acute myocardial infarction, acute limb ischemia, aortic rupture, stroke or transient ischemic attack (TIA) between January 1, 2019, and May 31, 2020, were included. Admission rates per 100,000 insured, invasive treatments and comorbidities were compared from January–May 2019 (pre-COVID) to January–May 2020 (COVID). A total of 115,720 hospitalizations were included in the current analysis (51.3% females, mean age 72.9 years). Monthly admission rates declined from 78.6/100,000 insured (pre-COVID) to 70.6/100,000 (COVID). The lowest admission rate was observed in April 2020 (61.6/100,000). Administration rates for ST-segment elevation myocardial infarction (7.3–6.6), non-ST-segment elevation myocardial infarction (16.8–14.6), acute limb ischemia (5.1–4.6), stroke (35.0–32.5) and TIA (13.7–11.9) decreased from pre-COVID to COVID. Baseline comorbidities and the percentage of these patients treated with interventional or open-surgical procedures remained similar over time across all entities. In-hospital mortality in hospitalizations for stroke increased from pre-COVID to COVID (8.5–9.8%).ConclusionsAdmission rates for cardiovascular and cerebrovascular emergencies declined during the pandemic in Germany, while patients’ comorbidities and treatment allocations remained unchanged. Further investigation is warranted to identify underlying reasons and potential implications on patients’ outcomes.Graphic abstract
Highlights
MethodsSince its outbreak in Wuhan, Hubei Province, China, in December 2019, the novel SARS coronavirus (SARSCoV-2) has spread rapidly, causing an outbreak of acute and severe respiratory illness worldwide [1]
While an association between acute viral respiratory disease and subsequent cardiovascular events had been described for other diseases [5, 6], several centers reported a decline in hospital admissions for acute cardiovascular and cerebrovascular emergencies during the COVID pandemic [7,8,9,10,11,12,13,14,15,16,17,18,19]
Comparing pre-COVID to COVID time frames, overall monthly admission rates declined from 78.6 per 100,000 to 70.6 per 100,000. This was observed across all strata (Fig. 1): admission rates per 100,000 during COVID compared to pre-COVID decreased for segment elevation myocardial infarction (STEMI) (7.3 vs. 6.6, − 12.2% percentage points, p.p.), non-ST-segment elevation myocardial infarction (NSTEMI) (16.8 vs. 14.6, − 15.2% p.p.), acute limb ischemia (5.1 vs. 4.6, − 12.4% p.p.), stroke (35.0 vs. 32.5, − 8.9% p.p.), and transient ischemic attack (TIA) (13.7 vs. 11.9, − 14.6% p.p.)
Summary
Since its outbreak in Wuhan, Hubei Province, China, in December 2019, the novel SARS coronavirus (SARSCoV-2) has spread rapidly, causing an outbreak of acute and severe respiratory illness worldwide [1]. While an association between acute viral respiratory disease and subsequent cardiovascular events had been described for other diseases (e.g., influenza) [5, 6], several centers reported a decline in hospital admissions for acute cardiovascular and cerebrovascular emergencies during the COVID pandemic [7,8,9,10,11,12,13,14,15,16,17,18,19]. Since acute cardiovascular and cerebrovascular diseases remain leading causes for morbidity and mortality, further investigation of this concerning trend is warranted to identify potential implications for both health-care professionals and regulators
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